{
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"FirstLineMailingAddress": "1602 LAKEWOOD DR",
"SecondLineMailingAddress": null,
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"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "42701-5458",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "270-505-5066",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "299 W LINCOLN TRAIL BLVD STE 102",
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"PracticeLocationAddressCityName": "RADCLIFF",
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"EnumerationDate": "04/15/2025",
"LastUpdateDate": "04/15/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NICHOLS",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}